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California State University, Long BeachCalifornia State University, Long Beach

Medicare and Your CalPERS-Sponsored Health Plan
Work Together to Keep You Covered

Medicare is a federal health insurance program that covers individuals age 65 and older. Medicare also covers some younger people with disabilities and people with End-Stage Renal Disease (ESRD is permanent kidney failure). If you are an Active employee covered under a CalPERS-sponsored health plan you cannot be enrolled in a CalPERS-sponsored Medicare plan unless you have Medicare due to ESRD.

Medicare includes:

  • Part A – hospital insurance
  • Part B – outpatient medical insurance
  • Part D – prescription drug insurance

Medicare Part A is free for most people (who have worked or who have/had a spouse who worked at least 10 years in Social Security and/or Medicare covered employment). Part A helps pay for the costs of inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care services. If you do not qualify for premium-free Part A, you may either qualify through a spouse or pay a premium to get Part A benefits. (For more details about Medicare benefits, read the Medicare handbook, Medicare & You, contact the Social Security Administration (SSA) at (800) 772-1213 or TTY (800) 325-0778, or visit Social Security Online The Official Website of the U.S. Social Security Administration.

Medicare Part B helps pay for outpatient medical care such as doctor visits. You must pay the monthly Part B premium. The premium is set by the federal Medicare program and can change each year. Some individuals under age 65 qualify for Part B due to Social Security Disability, and everyone qualifies for Part B at age 65.

CalPERS retired members who qualify for premium-free Part A, either on their own or through a spouse (current, former, or deceased), must enroll in Part B at age 65, or as soon as they qualify due to disability. They must then enroll in a CalPERS-sponsored Medicare plan.  When you retire and are age 65 or older, or if you qualify for Social Security Disability before age 65 and become eligible for premium-free Medicare Part A, you must sign up for Medicare Part B. At that time, you must also switch from your CalPERS Basic health plan to a CalPERS-sponsored Medicare plan or Managed Medicare plan (Medicare Advantage) in order to keep your health coverage through CalPERS.

Medicare Parts A and B will pay many of your health care costs, but they will not pay all costs. The CalPERS-sponsored Medicare plan will help you pay for costs not paid by Medicare, by coordinating your benefits. If you do not sign up for both Parts A and B, your CalPERS health coverage will be canceled. Enrollment by you or your family members in a CalPERS-sponsored Medicare plan or Medicare Managed Care plan (Medicare Advantage) will not affect other family members who are covered by the Basic plan. Any family members who do not qualify for Medicare will continue to be covered under the CalPERS Basic plan.

Contact the Centers for Medicare and Medicaid Services (CMS) for information on Medicare enrollment dates and benefits.  Centers for Medicare and Medicaid Services (CMS) (800) 633-4227 Medicare The Official U.S. Government Site for People with Medicare.

When Should You Start Coordinating Benefits?

Upon your retirement and three months before you turn 65, CalPERS will mail you notices informing you that it is time to coordinate your Medicare and CalPERS benefits. These notices will include a Certification of Medicare Status form. We use this form to obtain information from you about whether you qualify for Medicare and if you are enrolled in Medicare Parts A and B. You can also use the form to tell us that you do not qualify for premium-free Medicare Part A or that you are not applying for Medicare at this time because you or your spouse are still working and are covered by an employer group health plan.

You must return the completed form to CalPERS by the last day of the month in which you turn 65. For example, if you turn 65 on December 15, 2008, we must receive the form by December 31, 2008.

If you do not return the Certification of Medicare Status form by the end of your birth month, you will lose your CalPERS health coverage. In this case, your coverage would end on the first day of the month after you turn 65. If you lose your CalPERS health coverage, you would be required to pay for any hospital or medical services you use.

If you lose your coverage, you can enroll in a CalPERS health plan again only by proving that you have signed up for Medicare and completing the Certification of Medicare Status form. If your CalPERS Basic health plan coverage is canceled because you did not provide your Medicare status to CalPERS, you can request an Administrative Review. The Administrative Review process helps us decide if your CalPERS coverage should be reinstated. You must ask for an Administrative Review within 90 days of losing coverage.

To ask for an Administrative Review, write to:
CalPERS
Office of Employer and Member Health Services
P.O. Box 942714
Sacramento, CA 94229-2714

Once CalPERS has all of your information, they will review your request. They will tell you within 60 days if your coverage will be reinstated. If it is not reinstated, they will tell you why.